slt101

As your sons review is on Wednesday I am a little unsure what to recommend. I would say that it is easy to get into a "I don't believe" stance when arguing with the SLT, it would help your case to gather qualitative data to back up your concerns. Write down occasions (with quotes) when your son is unable to: infer and predict information ask for clarification use grammar well initiate conversation and maintain the topic being discussed to put his hand up and wait to be asked before talking to teacher understand questions BUT, we all know that sometimes ASD children can provide a different communicative picture in different scenarios, with different people. That?s what makes this area of working so challenging. If the SLT HAS observed your son doing all the things in her report then more focus should be placed on trying to generalise these skills. This doesn't automatically make this an SLT led activity, but help should be offered on establishing the right strategies to encourage generalisation. I would say that if you are ever concerned with an assessment or report you need to speak to the SLT to discuss those concerns. You can always ask for a second opinion. In my job I am the person who would complete second opinions for the service and it is good opportunity for all involved to air concerns and formulate a plan. There are no standardised assessments when working with children with ASD, tests can be used to help create a clinical picture of what is happening but cannot give you an age equivalent score. It is far better to have qualitative data from observations and indirect working with the child. I hope this makes sense.

If the OT is working in the NHS then they have to be correctly qualfied with appropriate registration with the COT and the HPC. You need to ask the OT if they are ASD savvy.

I AGREE!!! Then why do we need to test our children to tell us how words they may have in their vocabulary? We should be looking at the childs functional communication skills- how well do they use their language to buy items in a shop, catch a bus, i.e. activities of daily living. This has to be the biggest difference of opinion I share with parents. Many want their child to achieve the same level of academic success as their peers. I am interested in ensuring the child leaves school with as many skills of independence as possible, that may include some academia, but I prefer to use time out in the real world.

Thanks for that info.

Did she use standardised tests? Did the local NHS service totally agree with everything she put? Why didn't you carry on seeing the private SLT?

Can you tell me which test your SLT used? As you can probably guess I am not a fan of standardised tests with ASD children as they are not standardised with an ASD population. There, the results cannot be held to be 100% reliable. I have spoken with Helen who has been telling me of the staffing issues. It is not just your area with significant staffing difficulties, many areas are having difficulties with recruitment and retention of staff. There is a national problem which is going to get worse before it will get better. I have mentioned earlier something called Agenda for Change (A4C) which is the national re-grading of all NHS staff (excluding board members, doctors and dentists), this has effectively given senior SLT huge pay cuts of around 20-25%. The new working conditions for A4C also means that they are increasing the number of hours we have to work. In essence, more work for less pay. Not a good combination. This is not good for our kids but I do not have an answer. My department manager doesn't have an answer, her director doesn't have an answer. Do any have you got some answers to help solve this problem?

Paula, this is disgraceful and as a SLT I am embarrassed. I can not imagine why any qualified SLT would say something like this unless it was said in jest.

Once again I am not speaking in defence of what your SLT may or may not have done but therapy is more than sitting at a table doing "work", there is still MUCH confusion about what constitutes therapy. I get many funny looks if I get down on the floor with the child, reinforcing language through play for many children is far more beneficial than any tabletop activity. As with any professional some are better than others but if your child wandered off I am not sure what she could have done? Who was also in the room who could have helped? I am sorry you feel that you haven't had a positive experience with therapy, perhaps a new SLT would be able to change you perception?

I commented in an earlier post that I am not here to defend all SLTs but I did want to comment on some of the issues raised. I can see that you were unhappy at the service you received. My advice would be to get a second opinion, you don't need to go private you can ask the same SLT department for a reassessment of your childs needs. Looking at your comments on private SLT I would have to totally disagree, not all private therapists talk rubbish. I only know 1 private therapist who spouts out utter nonsense, the other 99% I know do a very good job. I am not a dysfluency specialist (stutter/stammer) but most approaches concentrate on self awareness/ self monitoring and therefore I don't think your child would benefit from SLT input. BUT as I don't know your son I would recommend that when you ask for a second opinion you could raise your concern about this issue. "Silly games"- illy, this is the approach widely used when working with children operating at a younger level. A non-direct game based technique is the most appropriate way of reinforcing language. It is clear that you were not aware why games are used which lead to this misunderstanding. Hope this explains a few issues. SLT101

Helen, I don't know what the answer is to the shortage question. There are record numbers of SLT qualifying, however, there are record number of SLTs leaving, and the Agenda for Change NHS National reorganisation is a disgrace. The Royal College of SLT audited a few years ago why people are leaving and one of the main reasons is stress. Trying to cope with a caseload of several hundred children can be very stressful. SLT Assistant courses are rare and always oversubscribed. Most offer the training for current assistants in post as they are then in a position to take the theory back into their work. But I will keep my eye open for you Helen just in case there is something suitable. Can you PM your general location to make sure I pass on the courses in your area. Perhaps you would like to go for SLT training. 4 year undergraduate course or 2 year Masters

In what way did they not listen to you?

Hello Helenl, Jo & BusyLizzie100 Thank you for all your comments. I thought it would be useful to try and respond to some of the new issues raised. Standardized Test: I am not sure how we go about gaining standardised testing for children with ASD children. Standardisation looks at forming a common core of development and then measure any deviance away from this ?core? . As you will be very aware there are no two ASD children the same and so gaining enough data to form standardised results would be an almost impossible task. SLT Practitioner: We currently have SLT practitioners, they are called SLT Assistants or SLT Technical Instructors. They are invaluable!! I couldn?t do my job without mine. It is very difficult to keep assistants as the pay is embarrassingly low, many go off to be LSA/TA in schools, to do a very similar job but be paid 50% more. I do have 2 families that refuse having assistants as the parents believe they are not getting the service their children need and will only allow FULLY QUALIFIED SLT, they even had that very specific provision written into the Statement. Staffing: I agree it must be frustrating when your therapist leaves and there isn?t a new therapist to immediately replace them. As you are probably aware there is a shortage of qualified SLT- plus it takes time to advertise and then interview and for the new therapist to work her notice on her previous job. It can take 3-4 months to have a new SLT in place. With recent changes in pay and conditions it will be much more difficult to recruit therapists as many senior therapists are having their pay frozen before it is cut, this protection is lost when you move jobs. It will get worse before it gets any better. ?No actual therapy is it??: I think you are still perceiving therapy as the 1:1, sit down and work through worksheets approach. During my visits I spend time observing in class, working with the child whilst in class and then spend the remainder of my time talking to the class based staff. I want to use my time to ensure that staff are giving the child as many communicative opportunities as possible, using the right strategies to reinforce appropriate language in context. Does that make sense? As mentioned in my earlier post, we need to reinforce language as and when the child needs it, in context, this cannot be achieved during 1:1 sessions. Pragmatic Profile: this can be a useful tool. Non-standardised. Providing you with a profile of your childs pragmatic language skills, measuring the appropriateness of language. This profile can be used in the planning of future input. I hope this extra piece information is helpful. SLT 101

HelenL & Bailyj Where should I start? Before I comment I do want to say that I am not defending all SLTs here but I wanted to add my comments on the issues addressed so far. Home v?s school visits: this is tricky. As a therapist I am pulled by the demands of the school and the demands from the home. I have always offered parents the opportunity to come into school to observe so allowing time to chat and advise on how support can be continued into the home. I do offer the choice of home visits but this replaces the school visit, although over the summer holidays I like to visit all my ASD children at home. Communication is far more than speech. I know that when most people talk about their child?s speech on the forum they are really talking about language. There have been many terms raised on the forum, receptive language/ expressive language/ semantics/ pragmatics/ language delay/ language disorder. It is no wonder that this can be extremely difficult to understand what all this means and what is the best way to help. Now this may sound controversial but more therapy does not always mean communication will develop any faster. We are always guided by the child. I have argued with some parents who believe that if I had visited their child once a week their communication would have developed much faster. Only children who are experiencing a specific language impairment need that level of intensive support in reinforcing individual components of language. Now, many of you here know how I feel about a private SLT who produces very detailed reports giving very specific activities that need to be completed. Parents like these reports because it lists everything. BUT I have a number of issues with this list of recommendations. Language is a social response. Why compartmentalise it into a list of very specific actions. Why study prepositions, adjectives, colours etc and work with worksheets, which are usually old/dated and inappropriate. Then expect it to be used in everyday language! If communication is a social response then reinforce it as and when it is socially expected. Social language groups are a good start but equally you need to truly understand the Means, Reason and Opportunity Model to help language develop. Then you will be able to reinforce language in the appropriate social context and not as part of a false 1:1 with a TA/LSA. I sometimes find Statements extremely overpowering, Child A WILL do 4 hours of a SLT programme even if they aren?t ready or willing on any specific day. I had a chat with a 1:2:1 after I recommended that she escorted the boy to a visit to the supermarket planned by the class- the horror on her face said that this would not be possible. ?We cannot miss our SLT time as the parent will lodge a formal complaint against the school- we HAVE to do our 1.5 hours of SLT programme time? What a crying shame, spend 1.5 hours of 1:2:1 or spend the time with his peers using this as an opportunity to reinforce the appropriate language linked with buying food at the supermarket. It seems that when you request a watertight programme you loose the social aspect which in my opinion is a far more important area to experience. Tests: There are no standardised tests for expressive/receptive language for an ASD population. We have a battery of assessments that have been standardised on a NT population and these have been used in the past when working with children with ASD. These results are not reliable. Many people in the past used assessments as a way of helping write a programme of support. The results are not valid so this cannot be a valid way of writing programmes. Specific teaching of specific language areas is not appropriate for ASD children. You are taking language out of context, and then expecting the child to use those concepts appropriately. Contacting your SLT: this must drive SLTs and parents equally crazy. Parents get agitated when they can?t immediately get hold of their SLT. SLTs get agitated when there is an expectation that they should be at their desk ready to take calls. I cannot speak for all SLTs but the reason I can?t take the call is because I am working in schools or on home visits. With over 155 children on my caseload it can be 3-4 days before I pick up my messages from the office. Private SLT: if you feel that you want more therapy for your child then private SLT may be an option. If you want to find a private SLT then this is the website for The Association of Speech and Language Therapists in Independence Practice. There is always another side to issues raised on the forum and I hope I have been able to add to the discussion SLT101

Couldn't agree more with you Helen on this. I burnt my worksheets years ago! I am putting together a response right now about all the issues raised in this topic. PS- Many thanks for your comments about SLT, it is nice to know that we are respected by families.

Helen you have me painted as some kind of mischievous contributor! But before I contribute to this discussion can you expand on your last comment "it has to be directed, dedicated and comprehensive" Thanks.