How do I deal with SALT?

[phlebas]

What I want from SALT:
1 - formal assessment of ds' expressive & receptive language skills.
2 - formal assessment of ds' speech production

what she says:
1- no point, it will underestimate his skills
2 - no need his speech production is age appropriate

how does she know?
1 - she visit every 6 weeks for 30 minutes, never interacts with ds, never sets goals, says that is the job of the ABA programme.
2 - she hasn't heard more than a couple of words from him - ds has MASSIVE speech production issues.

what she wants us/nursery do to:
1 - follow her Hanen pre-verabl child suggestions - put toys out of reach, spin wheels, hold up a paintbrush when we're going to do painting.
2 - communicate at 2-3 word level.
3 - use pictures to explain turn taking.

DS speaks at 5+ plus word utterances in spontaneous speech for all functions, understands what/where and is getting why, we're starting to get conversations - he his very delayed but the child she imagines is not the one I have in front of me - her suggestions are flabbergastingly inappropriate.

She's obstructive, vague and I am so angry; with this & the CAF I'm seriously considering taking ds out of nursery & refusing further contact with the lot of them. Is there any point in continuing to bang my head against the wall?

so cross I posted it twice

AND she's still droning on about PECS.

Suggest that you say that you want a standardised set of scores so that you can track progress over time.
You want a full CELF 4/ ACE test carried out and you look forward to receivng the results within 6 weeks or else you will commission a private report which you will then hold the NHS to.
The report should be specifc detailed and qualtified as to the support that she will need.

When I read your OP I thought to myself, 'what? no PECS?'

And then there it was

The only way to get what you want is to complain and complain.

You might have to search a few policy documents by the SLT professional body as they seem to be banging on about evidence based practice now, which would be impossible without baseline assements and measurable targets.

With every complaint I put in, I got a more senior SLT and doubled my input hours so ime it is the only way to do it.

Thanks Nigel & Star - that's what I thought, time to get writing. I feel like she's gaslighting me half the time - she is the senior complex communication disorder SALT, the one who took over when I went absolutely ape-shit about the community SALT we were dumped with.

I am not 'against' visual 'stuff' - we used a visual schedule for a couple of months with ds, to address a specific issue & we faded it asap. But of course DS is autistic & "'they' do need pictures don't they?"

I've written to her in the past requesting assessments & SMART targets obviously my letter writing skills need to improve because while she'd acknowledged them she's done fuck all about it.

It is so undermining with the nursery - we've just managed to persuade ds' key worker to come to a session so she has an idea of what he is capable of - being told to use pictures to explain turn taking is stupid, ds' favourite activites are multiperson turn taking games & circle time 'conversatiosn'. Some of the advice - model 'no' 'later' for ds to say when he turns his back on you & walks away from a demand - is bad ds does not need lessons in avoidance.

I was raging when I got her letter yesterday - note on her plan was 'copy communication opportunities ideas leaflet to parents as the may find it useful' - WTF this is stuff we were doing 15 months ago before ds had even seen a SALT.

What I want is for one of my tutors to go in as a shadow one nursery session a week [unlikely nursery will go for that]

& troublewithtalk thanks too - we're planning on getting a ICAN assessment done when ds is old enough, he's 3.8 now. We do have a good private SALT but we're skint now My feeling with NHS SALT is that she either needs to come up with something relevent to ds or we need to stop seeing her completely.

It's possible that she is right about the testing of his language skills. They won't use ABLSS or VBMAPP or anything that takes the fact that he is autistic into account so any result may make him look worse than he is as he will be compared with NT children of that age. There is a lot more to Hanen than bubbles. Ask if you can have exercises appropriate to his level - either Early Comunnicator or Partner not exercises for the wrong level.There are lots of great ideas about how to expand verbal language and conversation skills in Hanen. As for PECS, just keep saying it's not needed or wanted and don't get bogged down in explanations - I have found that can be counter productive not least because you waste precious time going over old ground.

In response to a complaint SLT services said that DS had not met his target of making choices because I wouldn't allow PECS!

FFS, since when was PECS about making choices?

WRT assessments. It is true that the assessments aren't appropriate for children with ASD, but they are STILL baseline assessments from which progress can be measured. And in the absence of anything else you do need something otherwise how are you going to measure progress?

FWIW I found the PLS 3 pretty accurate for ds (it isn't the best test as it isn't statsitcally sound) and there is a level of subjectivity, but you can get the same person to assess a year later for example.

And WHY are SLTs obsessed with bubbles?

DS does and always has been completely indifferent to them.

What is PLS 3 ?

That's what I need to find out about I think - all these SALT assessment tests - I don't know what would be most appropriate (would be nice if SALT was willing to discuss pro/cons with me - I'd appreciate her input). I'm sure that ds will test much worse than in reality (ah lightbulb! Maybe that's what she's worried about if we're refusing PECS & he tests really badly then she'll have to do something else?) - but we need some way of measuring progress.

We've done ABLLS/VBMAPP twice now with good progress, overall progress on the BIBIC assessments & we've done a phonics matrix - but I'm not a SALT & I don't have the skills to address some specific issues (we've introduced cued articulation which is what I think they do at the Nuffield dyspraxia programme; (good) SALT input would be helpful).

We use a lot of Hanen, I have no problem with Hanen based interventions - Two to Talk was a life saver for me in the early days & we use More than Words now - but this advice was not specific to my ds in any way & that makes me really angry. Will include my standard PECS is not appropriate blurb in the letter too.

Star wrt the bubbles - first time SALT met ds she brought out a car held it upside down & spun the wheels for him! Mental - he likes crashing cars & pushing cars under bridges and putting his animals in cars but has never spun anything. She could've just asked me what he likes (bubbles would've done nicely but only if he's allowed to do the blowing or has a very big stick to bash them with )

Over interpreting motives of SALTS is not always a good thing - I have found that they do not think about DS1 or his issues at all and that they do not really have motives as such. However if one existed, it might be more likely that she wants to say 'Oh look he scores badly compared to peers, PECS will help him learn to communicate.'

bumping this to update.

SALT did preschool CELF today, ds completed the testing which is bloody miraculous in itself! He did really badly - I'd be amazed if he scored above the 1-2nd centile because instead of answering the questions/task he chatted away about each picture. It did identify some gaps in his understanding - will repeat in 6 months.

SALT spent a long time with him & he was really very verbal (big leap since we went on holiday last month) - she assessed him informally at about 36 months which is about where ABLLS/VB-MAPP put him (he's 45 months now) - a last September he was testing at less than 12 months.

We've got his SALT provision increased to an hour every 3 weeks (doubled) & the SALT is going to attend our ABA team meetings to help set language goals. No mention of PECS etc she says she wants to support our ABA goals - certainly the goals she set today are pretty good imo - measureable etc

We've managed to get summer funding for ds to continue nursery (from Aiming High) & nursery (private) have agreed to let his keyworker do some ABA training with us in August (they'll fund it). I'm secretly planing to train her up as a tutor come September.

Reasonably good day all in all [will not follow that up with therefore tomorrow will be crap]

OMG just seen the date and realised that it is exactly 1 year since we first saw private SALT for ds & she recommended that we get referral to paediatric neurologist asap because she was worried he was profoundly deaf . That was the start of it all ...